Is Baby-led Weaning a feasible method for introducing complementary foods to infants in New Zealand?

Abstract

Baby-led Weaning (BLW) is an alternative method for introducing complementary foods to infants in which the infant feeds themselves hand-held foods instead of being spoon-fed by an adult. Anecdotal evidence suggests that many parents in New Zealand and elsewhere are choosing this method instead of conventional spoon-feeding. The aim of this thesis was to determine the feasibility of BLW as an alternative approach to introducing complementary food. To address this overall aim, five Aspects of Feasibility are investigated in this thesis, namely 1) What is the likelihood of parents meeting the prerequisites of BLW (i.e., exclusive breastfeeding to 6 months and introducing complementary food at 6 months)? 2) How acceptable is BLW to parents and healthcare professionals? 3) What are the current practices of those following a ‘BLW approach’? 4) What are the potential risks and benefits of BLW? 5) If there are risks, can these be addressed or minimised in a satisfactory way? The first two Chapters of this thesis examine whether support from a lactation consultant increased the number of women who were able to exclusively breastfeed until 180 days (the WHO recommendation) and subsequently delay the introduction of complementary food. Of the 803 mothers from the Prevention of Overweight in Infancy (POI) randomised controlled trial, 8.1% exclusively breastfed to 6 months and 12.6% introduced complementary foods at 6 months. There were no differences in the rates of exclusive breastfeeding or complementary feeding between the intervention and control groups at 180 days (6 months), but more women in the intervention groups delayed the introduction of complementary food until after 5 months. Mothers who smoked or had a higher BMI were less likely to exclusively breastfeed to 6 months, whereas there was a positive association with maternal infant feeding attitude. Being older and having a supportive partner both increased the odds of delaying solids until 6 months whereas there was a negative association with alcohol consumption during pregnancy. Phase two of this thesis focused on BLW in New Zealand. Interviews with 31 healthcare professionals showed that they had major concerns about BLW, principally to do with potential choking, iron deficiency, and inadequate energy intake. By contrast, 20 mothers who had used BLW successfully considered it to be a healthier and more convenient way to introduce complementary foods. However, choking was reported by six of these mothers – most commonly with raw apple. A nationwide survey was used to describe complementary feeding practices in New Zealand. Although 29% of parents consider themselves to be following BLW, very few (8%) were doing so strictly. However, the extent to which BLW was followed impacted on its potential benefits (e.g., sharing family meals) and risks (e.g. low-iron first foods). A modified version of BLW (Baby-Led Introduction to SolidS (BLISS)) was developed to address concerns around choking, and low energy and iron intakes. A 12-week pilot study in 23 participants showed that, compared to BLW, BLISS reduced offering of high-risk choking foods, and increased high-iron foods. Collectively these results suggest that although BLW may be advantageous for certain families, it may not be feasible for a large proportion of the population. Many questions regarding BLW still need to be addressed, specifically its safety and nutrient sufficiency, along with proposed benefits as reported by parents.